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A Safer Labor

Domingo, 10/May/2009Lewis WallThe New York Times

Motherhood is a blessing, but in many parts of the world childbirth leaves women permanently injured and turns them into social outcasts.

In West Africa, only about 1 percent of pregnant women have Caesarean deliveries because the procedure isn’t widely available. When labor is obstructed, the baby is trapped in the pelvis, and labor can last up to a week.

Women who survive this ordeal can develop a hole in the bladder called a fistula. This injury — caused by the prolonged pressure of the baby’s head on the soft tissues of the pelvis — causes continuous and uncontrollable loss of urine. The millions of women in Africa and Asia who suffer from fistulas are often shunned by their communities for the rest of their lives.

In Liberia, I operated on a woman who had endured a fistula for 35 years, and it took only 20 minutes to repair her injury. Including a month of hospital care and the surgical supplies needed, the operation costs about $300 to $450. All a clinic needs is spinal anesthesia, intravenous fluids, basic surgical instruments, sutures and a catheter for draining urine.

It’s even easier to prevent these injuries from happening in the first place. With supervision, local village “labor monitors” can learn to track the progress of a birth and send the woman to a hospital when labor lasts too long. Trained birth attendants can detect abnormalities in labor by using a partograph — a simple graph that charts the progress of labor and tells attendants when to intervene.

The World Health Organization tested the partograph in 35,000 births in Southeast Asia and found that using it cut the number of prolonged labors almost by half. Widespread use of this simple early warning system would go a long way toward saving babies’ and mothers’ lives — and making fistulas a thing of the past.

L. Lewis Wall, a professor of obstetrics and gynecology and anthropology at Washington University, and the president of the Worldwide Fistula Fund.